الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Parotidectomy is a common performed operation in head and neck surgery field. Many surgeons routinely use postoperative drains because they believe that a drain in the parotid bed obliterates the dead space and evacuates any collected haematoma or seroma, while multipleresearches have failed to prove any advantageofpostoperative drainage.
In parotidectomy scalpel and electrocautary can be used in raising the skin flap. Surgical incision using a scalpel was the best method for creating surgical wounds for a very long period with advantage of avoiding surrounding tissue thermal damage and also electrocautary has advantages of less intraoperative blood volume loss and good haemostasis.
The present study aimed to compare parotidectomy with drain insertion versus parotidectomy with no drain insertion regarding postoperative hematoma, seroma, postoperative pain and hospital stay, and to compare parotidectomy with scalpel versus electrocautary regarding postoperative hematoma, seroma and the flap integrity. This randomized controlled prospective study included 40 consecutive patients, suffering from parotid swellings divided into 4 groups, group A included 10 patients for parotidectomy using scalpel in raising the skin flap and postoperative drain insertion, group B included 10 patients for parotidectomy using scalpel in raising the skin flap and no postoperative drain insertion, group C included 10 patients for parotidectomy using electrocautary in raising the skin flap and postoperative drain insertion and group D included 10 patients for parotidectomy using electrocautary in raising the skin flap and no postoperative drain insertion.
There were 17 female patients and 23 male patients with male predominence and their age ranged between 18-78 years. All patients were subjected to thorough history taking and complete clinical examination and routine laboratory investigations followed by CT neck with IV contrast.
CT neck with IV contrast showed that there was no significant difference between the four groups as regards the size, site, number and features of the parotid mass.
Superficial conservative parotidectomy was performed in 29 patients (72.5%), enucleation was performed in 5 patients (12.5%), partial superficial parotidectomy was performed in 4 patients (10%), total conservative parotidectomy was performed in 2 patients (5%). The type of surgical procedures performed to the patients of the four groups didn’t differ significantly.
Intraoperative average blood loss volume in group A was (175-275) ml,in group B (150-250) ml, in group C (75-125) ml and in group D (75-125) ml. In groups A and B in which we used scalpel the average blood loss volume intraoperatively was significantly more than this which was in electrocautary groups C and D.
Assessment of postoperativehaematoma and seroma formation which was achieved by ultrasonography on day 10 postoperatively revealed that, seroma and haematoma formation in groups in which we inserted postoperative drain (A+C) didn’t statistically significantly differ from those in groups in which we didn’t insert drain postoperatively (B+D). Also in comparing groups in which we used scalpel in raising the skin flap (A+B) to groups in which we used electrocautary in raising the skin flap (C+D), there was no statistically significant difference in postoperativeseroma or haematoma formation.
Postoperative IV analgesia requirements in drain groups A and C was significantly higher than postoperative IV analgesia requirements in drainless groups B and D with 9 patients asked for IV analgesia in group A, 3 patients in group B, 9 patients in group C and 2 patients in group D.
The extent of flap integrity was similarly distributed in the scalpel groups (A+B) and the electrocautary groups (C+D). Although there was a slight increase in number of patients with flap integrity affection signs within the electrocautary groups, although there was no statistically significant difference between the groups according to flap temperature, pin brick, flap color or capillary refilling.